Dr. Harold Blum

Clinical Professor of Psychiatry and Supervising and Training Analyst, Psychoanalytic Institute, New York University Medical Center, and Executive Director of the Sigmund Freud Archives.

Leo’s contributions are in the area of psychoanalytic theory, in the area of psychoanalytic technique, in clinical psychoanalysis, and in what we call applied psychoanalysis, [where] psychoanalysis is applied to the humanities or to fields that are on the border of psychoanalysis, but are not strictly psychoanalytic. Contributions to theory – I would say that Leo’s investigations of the microscopic and macroscopic aspects of intrapsychic conflict were very valuable, very interesting, rewarding reading to this day. -- Dr. Harold Blum, Sept. 10. 2012

Dr. Blum continued:

A major clinical contribution, which is representative of his later contributions, was his paper on doll phobia which won an important international prize at the time it was presented.[1] That was a beautiful paper in terms of demonstrating at that particular time the value of ego-psychology and working from the surface to that understanding – the importance of defenses as well as unconscious impulses – compromised formation, and also the many, many different layers of meaning of the phobia.

MM: Doll phobia?

HB: Doll phobia. It may have left out certain perverse aspects of the patient but that’s viewed retrospectively for its time. We all have to – we’re all creatures of our time. Even [Sigmund] Freud said it about himself. For its time and its day, it was a wonderful paper both theoretically and clinically. It still makes very, very rewarding reading.

Let me get also to Leo’s discussions of technique, because in recent years – now I’m talking here really bringing us into the 21st century, because Leo’s books, My Life in Theory and The Road to Unity, were in the first decade of the 21st century. It’s a marvelous description of the evolution of psychoanalytic thought. It shows Leo’s interest in the nature of the various controversies that have evolved, his concerns about the tendency in recent years towards a kind of fragmentation of [psychoanalytic] thought, as he saw it. [Leo chose] more of an emphasis on the dangers of what we call pluralism with so many different theories dissolving into fragmentation. Then the possibility, you see – which I would have felt was an important counterpart to [obfuscation and fragmentation] – the theory [that] there was another side to this, which is the controversies themselves can stimulate ultimately new developments which can be progressive and positive in the evolution of psychoanalytic thought.

So there were two sides to it. Leo, I think, [over]emphasized more the negative, the dangers of a kind of dissolution, of a lack of cohesion, of confusion within the field, of non-recognition, of contradictions and so forth. The other side of [the intense controversy] was it might be a stimulus to analytic creativity.

MM: So he was trying to integrate different strains of theory.

HB: Right. Another of his ideas when he was [writing] about the theoretical developments in analysis was what he called total composite theory. His idea was to integrate the different strains, including some of the controversial strands and directions in psychoanalysis, in a way which he thought would allow the best and most promising of the newer ideas to be brought into the mainstream of analytic thought. The problem there was that it’s a wonderful idea but very difficult to achieve. This is in what Freud called the impossible profession. It takes a very long time to evaluate [new analytic ideas].

It’s not like you can use guinea pigs or mice and so forth. You have to follow human beings over a long period of time, to really test and evaluate these different strains in analytic thought and technique. And there is no longer agreement. In Freud’s day, Freud thought he was the arbiter of what was considered to be psychoanalytical or was considered to be non-analytical, what was considered to be acceptable or to be non-acceptable. What would be in the field and under the umbrella of psychoanalysis or what would be outside psychoanalysis. In those days, people left the field, like [Carl] Jung and Adler, or like Reich and so forth.[2] Today there are very large disagreements, but people stay within the umbrella of psychoanalysis and that has its advantages also as well as its disadvantages, its pros as well as its cons. Leo’s idea of total composite theory is elegant and it’s an ideal; but one that I think cannot be realistically achieved. There’s just too much disagreement, too much of a difference in points of view, and one cannot decide whose ideas are necessarily better.

Leo thought that over time what was valuable, what was generally an advance in analytic thought, could be integrated after it has been assessed through clinical work and reevaluation over time. It’s a fine ideal but in actual practice at the present time it doesn’t work because there are very serious problems. It takes a very long time for these different strands and different trends in psychoanalytic thought to evolve and to be tested in first of all, clinical work, as well as their theoretical compatibility with other ideas and probably in the long run in the future, with neuroscientific contributions. The people or colleagues who represent one viewpoint are not simply convinced that opposing or different viewpoints, not necessarily in opposition but different viewpoints, are necessarily better. And because of questions I’ll come to in a moment, it is very difficult to assess which ideas in the long run will prove to be of the greatest value and will ultimately be absorbed into the mainstream of psychoanalysis.

Some of the ideas and trends acquired a semi-orthodoxy of their own even when they were different from mainstream. They became pretty much fixed in their point of view and that because of issues of group loyalty, of inter-identification within the group, of what we might describe as narcissistic investment in certain analytic formulations and a host of other issues, including a person’s identification with a particular group. What Leo had really described, but didn’t make use of fully – the transference to theory, that the transference to one’s teachers became displaced onto their theoretical formulations. So some people became so to speak locked into those particular trends or formulations or concepts.

MM: That’s really, really interesting.

HB: Leo did a [careful] analysis of some of the problems in the field just in those terms. Problems that arise because of loyalties, problems that arise because of transference, problems that arise because of what he thought was castration anxiety, unresolved anxieties, problems of dependence, dependence on one’s teachers, dependence on one’s group and so forth – even issues of economics, that referrals came from the group that you were attached to and so you became even economically at times dependent on your particular group.

MM: That’s very insightful.

HB: Yes. It was very insightful and I think Leo could have extended it more to himself. [laughs] But he did a fabulous job and we all have our limits. I think, given all that he contributed over the many, many years, over a lifetime of work, his contributions were [prolific]. [Limitations] could be said of all of us. It always behooves us to look at our biases, our prejudices, and our preferences. One can even say that sometimes a preference is a form of prejudice.

I think Leo did [an in-depth] dissection too of the some of the problems we’re confronted with. I didn’t get to the stress on technique. In my opinion Leo’s concerns, his fears about the misuse of self-disclosure, the analyst revealing too much of himself and the interpersonal aspects of psychoanalysis, were quite important. But again there’s always a question of how much – if the analyst is sick, if the analyst is depressed, and so on. There may be a place in terms of the honesty – what Freud said [was that] analysis is based on the love of truth and having the patient really feel what is going on is completely candid between the two of them – between the two parties in analytic work.

Some degree of self-disclosure may be important. It may be important to say to a patient that I have an [illness]. I’ll be out for a couple of weeks or for an indeterminate period or whatever. One doesn’t have to go into every detail at all. On the other hand, “How many children do you have, Doctor? Do you have boys or girls?” That’s grist for the mill [without needing an answer]. Because we want to know what [are] the patient’s fantasies, what the patient imagines, what the patient thinks or hopes. “I hope you have a daughter, so you know something about what it’s like to raise a girl,” [if] you’re a male analyst. There’s a question of self-disclosure to the benefit of the patient, versus self disclosure for the benefit of the analyst. Is it really useful, therapeutically? Clinically? Is it interference? Is it a seduction? [Is it self-aggrandizement?] Is it an attack in a subtle way on the patient or is it a genuine benefit to the analytic work and is it in keeping with the overall principles of psychoanalysis?

Now I think Leo explored that very well. Other areas, I think, still remain for discussion. I think, for example, when Leo brought up his concerns about the change from a one-person psychology to a two-person psychology, I think there is something definitely to be said for his concern and his point of view. But again, one would need more balance today. We have both a one-person and a two-person psychology and the analyst’s personality is always there. It’s part of the patient’s external reality; it’s part of the reality of the analytic work, just as the analyst’s gender. For example, [with] two women who work together from the outset, a female analyst and a female patient, there’s much more likelihood initially for a mother transference. Freud was aware of that, even though the transference can be completely irrational. And it’s based on fantasy, not really so much at all on reality. It’s a compromise that includes both.

But the same thing would pertain to two men who work together, a male analyst and a male patient, but as the analysis evolves, one would expect that transferences from the mother, from the father, from the siblings, would all come into the treatment. So we do take into account the realities of the psychoanalytic situation. Some analysts confronted with the patient [who] needs a second analyst. You might say, well, he worked with a man and they want a good reason for thinking that the patient might now do better working with a woman. That [idea] goes back really to very early analytic work.

So we take into account the realities of the analyst situation – whether the analyst is ill, whether the analyst is obsessive and the desk is perfectly arranged and everything in order and the humidity of the room carefully controlled, or whether things have been scattered in the analyst’s office and so forth. All of this lends its own flavor to the analysis and we have different styles of interpretation. No two analyses can be identical. But I want to add a proviso: one would expect that the major conflicts of the patient would be analyzed, whoever the analyst is. There’d be variations. It would never be the same, but the major issues, the major conflicts, the major problems that the patient has been struggling with would be addressed, hopefully, whoever the analyst was.

Now another proviso: it will also vary with the school of thought within analysis so that an analysis by a Freudian and an analysis by an object relations theorist[3] and an analysis by a self-psychologist or by a Kleinian therapist[4] will all be somewhat different. But they will overlap. They will overlap, but there’d be significant differences and those differences are not going to be easily resolved. We can talk about total composite theory but we have not been able to by any means resolve the differences nor should the differences be papered over. [Theoretical] contradictions [and] irreconcilable [concepts should not] be overlooked or [avoided to serve a false sense of harmony].

At the same time we can understand the value of some of the different points of view. For example, Melanie Klein’s description of splitting, in terms of an all-good object and an all-bad object, is very important. One has only to think in terms of the medieval distinctions between God and the Devil. God was the all-good object, the Devil the all-bad object; and in more modern times, the idealization of the Aryan by the Nazis as all good and the Jew was demonized as all bad. That was a very significant contribution by Melanie Klein. And [Heinz] Kohut did give us self-psychology with very significant additions to our understanding of narcissism – the narcissistic transferences and the importance of the narcissistic counter-transference.[5] The analyst who can be grandiose, the analyst who can have a feeling, perhaps it’s unconscious – he’s got the [only] answer [or] she’s got the [one] answer – that kind of omniscience.

So it’s wonderful to think we can integrate and it’s an ideal yet to be achieved, but it seems right now that we are a very long way from that. And we do have these very different schools of thought which have made their own contributions but are also very different from each other and which include aspects that we don’t accept in the other person’s, or the other school, of thought. [Some theories are incompatible.]

MM: Right. And other schools can be very cross-fertilizing.

HB: Very cross-fertilizing, even creative – at least fostering creativity, but in other ways also looked upon as not psychoanalysis but a form of psychotherapy or as departing from basic psychoanalytic insights and concepts and so forth. Now Leo [analyzed], too, some of the fields and schools of thought taking one area – pars pro toto – taking one part of analytic theory and elevating it to a total theory, as one of the major reasons for some of the dissension and the evolution of different schools of thought. I think there’s a good deal of wisdom in this but it is by no means, when we look at the whole picture, the only reason why we have differences in schools of thought, differences in theory and differences in technique.

[1] Rangell L. (1952). The Analysis of a Doll Phobia. International Journal of Psychoanalysis 33: 43-53.

[2] Carl Jung (1875-1961), Alfred Adler (1879-1937), and Wilhelm Reich (1897-1957) were all early associates of Sigmund Freud (1856-1939). Jung was Freud’s disciple and close associate from 1906 to 1913, but his theory of the collective unconscious (expanding on Freud’s concept of the personal unconscious) eventually led to a permanent break between the two men in 1914. Adler was a colleague and cofounder of psychoanalysis; after developing his own ideas on personality theory, he and his supporters formally left the Vienna Psychoanalytic Society in 1911. Reich, one of the “second generation,” was director of Freud’s outpatient clinic in the 1920s; he began to focus on character analysis and sex education, and began to deviate from psychoanalytic practice from 1930 onwards.

[3] Object-relations theory describes the dynamic process of psychic growth and development in relation to family and other close relationships. The concept was introduced by Otto Rank (1884-1939) in the 1920s, and more extensively developed by Ronald Fairbairn, Melanie Klein and others in the 1940s and 1950s.

[4] Melanie Klein (1882-1960) was an Austrian-British psychoanalyst who worked extensively with young children, developing play techniques that she saw as helping to reveal aggression and anger, life and death instincts, at very early ages. She was a leader in object-relations theory.

[5] Heinz Kohut (1913-1981) an Austrian-American psychologist, developed self-psychology, which considers disrupted or unmet developmental needs to be the root causes of psychological disorders, at the University of Chicago in the 1960s.